Cases: Benign Prostatic Hypertrophy (BPH) as a hospice diagnosis?
Conclusion: In this case, a simple condition that is easily treatable in most men became one that we expected to lead to Mr. K’s death. However, the diagnosis that led it to become life-limiting was Mr. K’s dementia, and the heavy burden which BPH treatments would have placed on him. Mr. K’s daughter based her decision on Mr. K’s values, saying that if the father she was raised by was able to see himself in his current condition, he would have wanted both to stay in place and to be allowed to die with dignity. Forced catheterization and antipsychotic treatment might have prolonged his life by years but would have caused terrible suffering to himself and his family. With the decision to allow his BPH to progress with minimal intervention, we were able to discharge Mr. K to enroll in hospice at his nursing home and completed a POLST form indicating “comfort measures only”. References:1.) American Urological Association Guideline: Management of Benign Prostatatic Hyperplasia (BPH) 2010. http://www.auanet.org/education/guidelines/benign-prostatic-hyperplasia.cfm Accessed August 24, 2014.2.) Burnett AL, Wein AJ. Benign prostatic hyperplasia in primary care: what you need to know. J Urol 2006; 175:S19.3.) Dull PD, Reagan RW, Bahnson RR. Managing benign prostatic hyperplasia. Am Fam Physician. 2002 Jul 1;66(1):77-85. Open AccessOriginal Case by Julie Childers, MD, Edited by Christian Sinclair, MDOriginally posted at the Institute to Enhance Pall...
Dr. Laura Esserman answers the door of her bright yellow Victorian home in San Francisco’s Ashbury neighborhood with a phone at her ear. She’s wrapping up one of several meetings that day with her research team at University of California, San Francisco, where she heads the Carol Franc Buck Breast Care Center. She motions me in and reseats herself at a makeshift home office desk in her living room, sandwiched between a grand piano and set of enormous windows overlooking her front yard’s flower garden. It’s her remote base of operations when she’s not seeing patients or operating at the hospita...
Seventy percent of the global population do not have access to safe and affordable surgical and anaesthesia care, and 90% of them are found in the low-and-middle income countries. The WHO considers perioperative mortality rate (POMR) as a gross indicator for safe surgical practice. We aimed to descriptively assess the POMR of our low resource non-governmental organization (NGO) hospital in India.
Surgery has formerly been called the ‘neglected stepchild of global health.’ Although significant progress has been achieved in bringing surgical care to the forefront of global health discussions, the state of surgery in many Low- and Middle- Income Countries remains unchanged. A number of these countries are in the process of dev eloping National Surgical (including trauma), Obstetric, and Anesthesia plans (NSOAP), the vehicle that will be used to scale up surgical capacity. We aimed to describe the initial steps towards the development of the Kenya NSOAP and the development of the Kenya National Hospital Ass...
Exercise is beneficial for skeletal muscle functions across all ages. However, the response to exercise shifts with aging, resulting in anabolic resistance and limited gain in muscle strength and endurance. These changes likely reflect age-related alterations in transcriptional response underlying the muscular adaptation to exercise. The exact changes in gene expression accompanying exercise are largely unknown, and elucidating them is of a great clinical interest for optimizing the exercise-based therapies for sarcopenia.
Telehealth has become mainstream during the COVID-19 pandemic, but its role in managing older patients is not well defined. This systematic review aims to assess the postoperative benefits of perioperative telehealth interventions in older adults.
With rising life expectancy and low birth rates, elderly people make up an increasing proportion of the population of the United States. Studies estimate that by 2050, the nonagenarian population will reach 8.7 million. Elderly people have significant medical care needs and their need for surgical care will require nuanced evaluation of their surgical candidacy and operative risks.
The hypoxia signaling pathway plays a pivotal role in the regulation of metabolic response during muscular adaptation to exercise. To explore the role of hypoxia signaling in exercise performance, we generated a transgenic mouse model with inducible, skeletal muscle-specific knockout of ARNT (ARNT mKO).
In this study, we identified geriatric surgical service interventions most relevant to EGS patients.
Woman,over age 70, compose 30% of breast cancer cases. Over expression of HER2 occurs in 15% of cases. NCCN guidelines recommend systemic treatment for tumors over 1 cm. The Charlson Comorbidity Index can quantify multiple comorbidities and predict a limited life expectancy that allows stratification of women over age 70 who may not benefit from systemic treatment of HER2 breast cancer.
The association of frailty on postoperative outcomes after elective and emergency general surgery (EGS) procedures are widely examined. However, this association has not been examined in the geriatric population stratified by EGS procedural risk.
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